Performance indicators; the association between the quality of preventive care and the prevalence of hospital-acquired skin lesions in adult hospital patients

Aim: The aim of this study was to explore the relation between the occurrence of pressure ulcers or incontinence dermatitis and the quality of preventive care provided.

Background: Performance measurements using indicators has become standard practice in recent years. The prevalence of pressure ulcers with or without incontinence dermatitis is widely used as an indicator of the quality of nursing care.

Design: Matched case-control study.

Methods: We collected information on 132 patients selected from a prevalence study (April 2010). We matched 88 controls to 44 cases, controlling for duration of hospitalization and type of nursing unit. We wrote 132 patient reports, including patient factors and process criteria, using a chart review. Five expert teams assessed nine processes of care with guideline-based review criteria. The expert teams assessed the reports blinded for outcome. The care process was assessed using a four-point quality score ranging from optimal care to suboptimal care.

Results: In a multivariable analysis using conditional logistic regression, the pressure ulcer risk score and the quality score were associated with a poor outcome after adjustment for type of illness, age, care needs prior to hospitalization, intensive care stay during admission and the number of care problems.

Conclusion: We found that the development of pressure ulcers or incontinence dermatitis was associated with the quality of the preventive care process, indicating that variation in their prevalence reflects variation in the quality of care.